PubMed Health⌕ Search

Biomedical subjects

R B Lydiard

Publications and source records attributed to R B Lydiard.

At least 55 records · Page 3Linked to original sources
PubMed1997

Effects of the cholecystokinin agonist pentagastrin in patients with generalized anxiety disorder.

OBJECTIVE: The anxiogenic and panicogenic effects of peripheral administration of the cholecystokinin-B receptor agonist pentagastrin and placebo were evaluated in patients with generalized anxiety disorder and normal comparison subjects. METHODS: Seven patients with generalized anxiety disorder and seven age- and sex-matched normal subjects received an intravenous bolus of placebo and pentagastrin. RESULTS: Panic attacks occurred in five patients with generalized anxiety disorder (71%) and in one normal subject (14%). Patients with generalized anxiety disorder were more likely to report more nonpanic anxiety than were normal subjects. CONCLUSIONS: Patients with generalized anxiety disorder appear to exhibit greater subjective sensitivity to pentagastrin than do normal subjects.

Anxiety Disorders↗
PubMed1997

A double-blind, placebo-controlled study comparing the effects of sertraline versus amitriptyline in the treatment of major depression.

BACKGROUND: This study was designed to compare the efficacy, safety, tolerability profiles, and effects on quality of life of the serotonin selective reuptake inhibitor antidepressant sertraline versus the nonselective tricyclic antidepressant amitriptyline and placebo in patients with major depression. METHOD: Outpatients with DSM-III-R major depression were randomly assigned to double-blind treatment for 8 weeks with sertraline (50-200 mg daily), amitriptyline (50-150 mg daily), or matching placebo. Assessments included the Hamilton Rating Scale for Depression, Montgomery-Asberg Depression Rating Scale, Clinical Global Impressions-Severity of Illness scale, Clinical Global Impressions-Improvement scale, Global Assessment Scale, Profile of Mood States, Beck Depression Inventory, Quality of Life Enjoyment and Satisfaction Questionnaire, and Health-Related Quality of Life battery. RESULTS: All treatment groups demonstrated statistically significant improvement from baseline in depression ratings by Week 1 and thereafter. The antidepressant effects of amitriptyline and sertraline were significantly (p < .05) greater than placebo and did not differ significantly from each other. Sertraline was associated with significantly (p < .05) greater subjective (i.e., patient-rated) improvement in mood than amitriptyline or placebo. Both active drugs were associated with greater improvements than placebo on most quality of life measurements. On several items, sertraline, but not amitriptyline, was superior to placebo. There was a discernible effect of sertraline earlier than amitriptyline on most quality of life scales. Amitriptyline therapy was associated with significantly more treatment-related adverse events, and discontinuations due to treatment-related adverse events, in comparison to both sertraline and placebo therapy. CONCLUSION: Sertraline and amitriptyline each were effective treatments for major depression as assessed by both physician- and patient-rated scales. These results show that sertraline therapy is better tolerated than amitriptyline therapy. Quality of life was also improved by effective antidepressant treatment, with sertraline showing a tendency to produce greater improvements on quality of life measures.

1-Naphthylamine↗
PubMed1997

Biological basis of generalized anxiety disorder.

Despite the considerable revisions to diagnostic criteria, recent data indicate that generalized anxiety disorder (GAD) is one of the most common anxiety disorders. Growing evidence also indicates that GAD is a serious illness, which frequently causes moderate impairment and often requires prolonged treatment. Thus, investigation of the biological correlates of GAD may be helpful in the development of effective treatments for this disorder. Recent data suggest possible abnormalities in the regulatory mechanisms of several important biological components in GAD patients. Maladaptive responses to stressful stimuli have been observed in the locus-ceruleus-norepinephrine-sympathetic nervous system, the hypothalamic-pituitary-adrenocortical axis, and the cholecystotin system. Abnormalities in other important CNS modulators, such as 5-HT and gamma-aminobutyric acid, may also be involved in the biology of GAD. In the following article, the authors will review the existing information regarding these potential biological abnormalities in GAD.

Anxiety Disorders↗
PubMed1997

Anxiety and the irritable bowel syndrome: psychiatric, medical, or both?

The association between the irritable bowel syndrome (IBS) and psychiatric disorders is well-known to most clinicians, but the nature of the relationship is far from clear. There is an increased prevalence of psychiatric illness in IBS patients and an increase in IBS in psychiatric patients. Whether this association exists outside of treatment-seeking populations (i.e., in IBS sufferers who do not seek treatment) has not been well investigated. This paper will selectively review the existing literature regarding the association of IBS and psychiatric illness in both patient and nonpatient samples. A model of the brain-gut interaction will be presented, as will practical implications of this model for treatment of individuals with IBS.

Aged↗
PubMed1997

Therapeutic trial participants: where do we find them and what does it cost?

Billions of dollars are spent annually in the process of developing and marketing new therapeutic agents. While the methods for testing and assuring safety of these newer agents receive intense scrutiny, the methods by which the patient samples for psychotropic agent studies are recruited has received relatively little attention. It appears that symptomatic volunteers who enter clinical psychopharmacology studies are clinically comparable to treatment-seeking patient samples. There is almost no information regarding the actual proportions of "recruited" to treatment-seeking patients or how many symptomatic volunteers participate in more than one study, and the expense of advertising for symptomatic volunteers has not been investigated. We surveyed 18 experienced investigators around the United States to identify: (1) the relative proportion of clinical trial participants who are symptomatic volunteers versus treatment-seeking patients; (2) the proportion of study volunteers who entered more than one clinical trial; and (3) the cost of recruitment for investigators who conduct these studies. The findings indicate that an average of 87.2 percent of subjects entering trials were recruited via advertising. Most participate in only one study. The expense of identifying and recruiting appropriate symptomatic volunteers is significant, and appears to be increasing. Implications of these findings will be discussed.

Advertising↗
PubMed1997

Panic disorder across the life span: a differential diagnostic approach to treatment resistance.

There has been significant progress over the past 30 years in our understanding of the treatment of panic disorder. There are now several different classes of pharmacological treatments, as well as cognitive-behavioral treatments that have been shown to have efficacy in treating panic disorder. Despite the increase in the knowledge base, many patients are only partially responsive or unresponsive to initial treatment efforts. A differential diagnostic approach to reviewing possible causes for treatment failure is presented. These causes include coexisting psychiatric disorders, unrecognized medical factors, environmental stressors, and others. Additionally, a review of factors specifically related to elderly and to very young treatment-resistant panic disorder patients is presented, along with some suggestions for evaluation and treatment. Based on the limited literature and clinical experience, practical clinical suggestions for approaching identified factors are presented.

Adolescent↗
PubMed1997

A double-blind evaluation of the safety and efficacy of abecarnil, alprazolam, and placebo in outpatients with generalized anxiety disorder. Abecarnil Work Group.

In a placebo-controlled, multicenter study, 180 male and female outpatients, ages 18-65, with DSM-III-R generalized anxiety disorder, were treated with abecarnil (a partial benzodiazepine agonist), alprazolam, or placebo for 4 weeks. This was followed by a rapid (1-week) taper, during which patients were assessed for any taper-related symptoms. All patients were identified via a structured clinical interview for DSM-III-R and randomly assigned to one of the three treatment groups. More than 70% of each treatment group completed the study. In the acute-treatment phase, both abecarnil and alprazolam showed evidence for efficacy that was significantly better than that of placebo. Both active agents were tolerated well. After the swift taper, a significantly greater number of taper-related symptoms occurred in the alprazolam-treated group than in the abecarnil-treated group, which was not different than in the placebo-treated group. Additionally, less residual improvement followed the taper in the alprazolam-treated and the placebo-treated groups. These data indicate that the partial benzodiazepine agonist abecarnil may be useful as a safe, effective, short-term treatment for anxiety. Theoretical and practical implications of these findings are discussed.

Adolescent↗
PubMed1996

Cerebrospinal fluid corticotropin-releasing factor concentrations in patients with anxiety disorders and normal comparison subjects.

Cerebrospinal fluid (CSF) concentrations of corticotropin-releasing factor (CRF) were measured in a group of patients with anxiety disorders and normal comparison subjects (NC) to explore the hypothesis that abnormalities in CRF neuronal regulation occur in patients with anxiety disorders. Analysis of variance (ANOVA) revealed no differences in CSF CRF concentrations between the four diagnostic categories: panic disorder (PD), generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and NCs. Male OCD patients had higher CSF CRF concentrations than men with PD and GAD and male NCs. CSF CRF concentration was positively correlated with age in women but not in men. These findings suggest that central neuronal CRF regulation may be affected by both age and gender.

Adult↗
PubMed1996

Panic disorder and social phobia: possible implications of comorbid depression for drug therapy.

Major depression is a common mental disorder with a lifetime prevalence of approximately 15% of the general population, affecting almost twice as many females as males. Panic disorder is a severe anxiety disorder with a lifetime prevalence of 2-3% or more. Like major depression, panic disorder affects nearly twice as many females as males. Both panic disorder and major depression are often chronic conditions, resulting in significant morbidity and mortality. Among patients who seek treatment for either panic disorder or major depression, both conditions are present in approximately one-third of the patient population. Substantial information suggests that individuals who suffer from both panic disorder and major depression respond poorly to acute treatment, are more likely to remain ill over the long term, require more psychiatric treatment, and are at approximately twice the risk of suicide attempts than individuals who suffer from either condition alone. There has been very little systematic study of individuals with coexisting panic disorder and major depression. This has left significant gaps in our knowledge about optimal treatment for the substantial subgroup of individuals suffering from both disorders simultaneously. Social phobia is a common disorder which affects 2-8% (females more than males) of the population. Recent advances in the pharmacological treatment of social phobia are reviewed. Patterns of comorbidity, effects of coexisting psychiatric disorders on disability, health care utilization and suicidality are discussed, together with treatment implications for coexisting social phobia and major depression.

Antidepressive Agents, Tricyclic↗
PubMed1996

Recent developments in the psychopharmacology of anxiety disorders.

Anxiety disorders are the most prevalent mental disorders in the United States. In the past 3 decades, substantial advances have been made in the ability to identify and treat anxiety disorders including panic disorder (PD), social phobia (SP), obsessive-compulsive disorder (OCD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD). It is now known that these common, usually chronic disorders confer significant disability to untreated sufferers. This overview highlights some of the important advances in pharmacological treatment of anxiety disorders. Evidence for efficacy of the various pharmacological agents (including relevant oral dosing and plasma-level data) and of acute and long-term treatment, and the disadvantages of medication treatment are discussed. Finally, some important clinical questions remaining to be addressed by psychopharmacological research are reviewed.

Adrenergic beta-Antagonists↗
PubMed1996

Comorbidity of posttraumatic stress disorder and irritable bowel syndrome.

BACKGROUND: Irritable bowel syndrome (IBS) is a chronic disorder that has been found to be associated with psychiatric disorders and a history of physical and/or sexual abuse. To date, the relationship of posttraumatic stress disorder (PTSD) and IBS has not been investigated. The primary purpose of this study was to examine the relationship of IBS and PTSD. METHOD: Fifty consecutive IBS patients admitted to a clinical treatment study were assessed for IBS, trauma history, and psychiatric disorders. RESULTS: Twenty-seven IBS patients (54%) met criteria for a psychiatric diagnosis at some time in their lives. Twenty-two patients (44%) reported a trauma history. Eighteen (36%) were diagnosed with PTSD. Those IBS patients with a trauma history were more likely to have other comorbid psychiatric diagnoses. CONCLUSION: These results suggest that IBS is often associated with psychiatric disorders, indicating that assessment and treatment of these comorbid conditions may be important in the treatment of IBS. PTSD, which had not been previously investigated in relation to IBS, had a high prevalence, indicating the need for careful trauma and PTSD assessment in patients with IBS. Patients with IBS who have a trauma history may be more at risk for other comorbid psychiatric disorders than IBS patients without a trauma history.

Adolescent↗
PubMed1996

Generalized anxiety disorder: issues in epidemiology.

Despite the considerable attention that has been focused on the anxiety disorders by the medical and research communities over the last decade, relatively little attention has been devoted to the investigation of generalized anxiety disorder (GAD). However, the available population-based studies have provided clinically relevant information about this disorder. The emerging picture is that GAD is a common and chronic disorder, affecting primarily women, and one that leads to significant distress and impairment. Subjects with GAD frequently utilize health care services and require medication treatment. Since a major portion of health care services is consumed by a small fraction of patients, early detection and effective intervention may reduce unnecessary and costly health care.

Adult↗
PubMed1996

Fluoxetine in the treatment of anger: an open clinical trial.

BACKGROUND: Intense anger, easy irritability, and low frustration tolerance are frequently encountered in clinical practice and may occur as part of the constellation of symptoms associated with a number of Axis I and Axis II diagnoses. Recent studies have suggested the efficacy of fluoxetine in treating anger in depressed and borderline patients. The present study examines the treatment of anger as a target symptom regardless of accompanying psychopathology. METHOD: In this preliminary trial, 11 subjects experiencing intense anger were treated in an open-label fashion with fluoxetine over an 8-week period. Anger was measured by a clinician-administered Clinical Global Impressions-Severity (CGI-S) scale and a self-report anger inventory, the Multidimensional Anger Inventory (MAI). The Hamilton Rating Scale for Depression was administered at baseline and final visits. RESULTS: All 11 enrolled patients completed the study, and all patients demonstrated clinical improvement as measured by both the CGI-S and the MAI. Nine patients were rated as responders and 2 as nonresponders according to prospectively established criteria. Fluoxetine was well tolerated and showed rapid onset of action. CONCLUSION: This study is limited by small sample size and nonblinded, open-label design, but nonetheless suggests that fluoxetine may be useful in moderating anger as it occurs as part of the symptomatology of a number of Axis I and Axis II disorders. Controlled studies are warranted.

Adult↗
PubMed1995

Double-blind parallel comparison of three dosages of sertraline and placebo in outpatients with obsessive-compulsive disorder.

BACKGROUND: Anecdotal evidence suggests patients with obsessive-compulsive disorder (OCD) are treated with selective serotonin uptake inhibitors at dosages significantly higher than those used with depressed patients. The current study examined the efficacy, safety, and optimal dosing strategy of sertraline in patients with OCD. METHODS: Three hundred twenty-four nondepressed outpatients with OCD from 11 sites followed identical protocols using a double-blind parallel design. Following 1 week of single-blind placebo, patients were randomly assigned to 12 weeks of treatment with one of three fixed dosages of sertraline (50, 100, or 200 mg/d) or placebo. RESULTS: Sertraline patients exhibited significantly greater improvement (P < .05) at end point than placebo patients on all three main efficacy measures in the 50-mg/d and 200-mg/d groups and on one measure in the 100-mg/d group. The placebo response was larger in this population of subjects with OCD than in those previously studied. Adverse experiences were common in the sertraline and placebo groups and appeared to be dose-related in the sertraline-treated patients. CONCLUSIONS: Results support the safety and efficacy of daily dosages of 50, 100, and 200 mg of sertraline in the short-term treatment of patients with OCD.

1-Naphthylamine↗